Background: Goal directed therapy (GDT) is able to improve mortality and reduce complications in selected high-risk patients undergoing major surgery. The aim of this study is to compare two different strategies of perioperative hemodynamic optimization: one based on optimization of preload using dynamic parameters of fluid-responsiveness and the other one based on estimated oxygen extraction rate (OER) as target of hemodynamic manipulation.
Methods: This is a multicenter randomized controlled trial.
The industrial processes require large quantities of water. The presence of discharges results not only in significant environmental impact but implies wastage of water resources. This problem could be solved treating and reusing the produced wastewaters and applying the new zero liquid discharge approach.
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